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I am POA for 86 YO mother in a nursing home. It's no surprise that her remaining years are unknown, but she is doing ok. She has United Health Medicare and has for some time. I have recently been contacted (more like hounded) by a rep who wants to change her Medicare to a nursing home plan. Yes, it's cheaper, yes this will (supposedly) have a Medicare nurse check on her monthly, but the research I've done doesn't really tell me much more than that. Has anyone made this kind of change in their Medicare plan? Any advice or red flags I should be aware of? Thanks so much!

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They are trying to SELL you something; keep this in mind. Don't answer the phone to this bloodsucker again. If you are satsfied with your mom's insurance plan, keep it. If your mother is elibigle for hospice care you have the right to choose which hospice service you use, and a not-for-profit is nearly always much much better than the for-profit ones. You pay nothing for any hospice service but the for-profits seem to pad their bills to medicare by requesting all kinds of unnecessary add-ons (new matress, etc.).
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Vivian711 Mar 19, 2019
Right on. These people are salesmen. Unscrupulous salesmen HOUND people. Red flag. Block them on your phone.
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Your Mother already has a Medicare Advantage plan... that is what United Healthcare Medicare Replacement is. Medicare "nursing home" plans do not exist, as Medicare does not pay for Long Term Care. If she is currently receiving Skilled Rehab services at the Nursing Home, then her insurance (Medicare Replacement United Healthcare) would/should be covering the short term services. Other than the short term Skilled Rehab services, again, Medicare NEVER pays for long term care. If, for instance, UHC is out of network with her Nursing Home for Skilled Rehab then transitioning her back to traditional Medicare Part A with another Part B (and others) or a supplemental/gap policy IS the best plan action. Medicare Part A is IN-NETWORK with every Medicare- Certified Nursing Home, whereas United is not.... and that can be VERY costly.

You must absolutely take these concerns and questions to her Nursing Home's Social Worker and Administrator. ONLY they will be able to guide you in the best possible insurance setup for your Mother at this point, and even assist in the transition if you/she would be better covered with such. Each individual nursing home is in-network with a different array of Replacement/Advantage, Supplemental/Gap, and Commercial insurance plans. You need to be IN-NETWORK with the appropriate plan(s) that are actually going to cover your Mother's costs when the need arises and she needs the Skilled (short-term) services that her NH provides. (Example: she breaks her ankle and needs extensive therapy to recover, along with a higher level of nursing services).

If it turns out that you are being harassed by a scam plan, then ask the Social Worker to assist you in reporting the company and contact information to the appropriate authorities and/or hotlines.
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Anyone who approches you to change a Medicare plan is violating a federal law. Check it out and ask the person about it
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Sendhelp Mar 16, 2019
Does it count if the "agent" sets up at a table in the lobby of a well-known plan clinic? Sign says, ask us about Medicare.....an expert!

Then it is discovered, has ALL plans, from other providers.

Pushes THE PLAN of the clinic.
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It sounds like a Medicare Advantage Plan. You may have only recalled or heard "nursing home plan". It very well could be a SNP-I. A Special Needs Plan - Institutional. These Medicare Advantage Plans are a great fit for many. Increased benefits and services at, generally, lower or no cost. Ask for printed material. If it is a Medicare Advantage Plan all materials are approved and will clearly document if government approved, will have numbers to call with questions, etc.
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Prior to the NH Mom had Aetna Medicare. The NH suggested we switch to the United Healthcare NH plan and I researched and found it was better. In her NH it provides an on-site fulltime Nurse Practitioner for approx 60 residents who can write scripts. This has been invaluable and saved doctor visits. Will your Medicare nurse actually be a NP that can write scripts? Your NH already should have a full time regular RN on staff so I don’t see the big benefit of a monthly RN visit.
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ArtMom58 Mar 15, 2019
Thank you for your answer. It was helpful. I will ask about the NP writing scripts as I don't know.
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Having much trouble selecting a plan.

But I believe the difference is
1) a PPO plan (supplemental Medicare plan) allows you to choose your health care providers, but may cost more. Must go outside the NH for care.

2) An HMO plan (Medicare advantage plan) costs less, or can even be free because one assigns their Medicare benefits to the plan. This takes your choices away, you pay for a low premium, makes one have to wait to be approved to see a specialist, one "receives" only what is called "the standard of care" provided the same to all patients.

Imo, this "standard of care" is what gets a patient statins, b/,p meds, pain meds in lieu of treatment and cure, and g.e.r.d meds---all whether a patient actually needs them , or not. And, also, the standard dip stick urinalysis or a denial to test for a UTI, all to save on medical expenses for the plan.
IMO, disclaimer, disclaimer, disclaimer.

I could be wrong, but I don't care. I have "Stand alone, original Medicare".
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rocketjcat Mar 16, 2019
For myself with minor medical issues and just starting with medicare I chose an advantage plan. My DH who has some bigger issues and wants to make sure he has everything covered has a medicare Plan F which is expensive.
But a Nursing Home plan is specifically targeted to NH residents and will be different from either than these.
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This sounds strange to me. I would ask them if the nursing home plan is selected, then what happens if mom has to move to another facility? Do you have to try to get her existing plan back again?
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rocketjcat Mar 17, 2019
“United Health Care Nursing Home Plan” isn’t specific to a particular nursing home. It just means they are in a nursing home vs in the community on a regular Medicare plan.
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You might also ask at your Nursing Home, as usually they have an ombudsman (sorry -- spelling) who has a lot of knowledge in these issues. If there is no one there with any knowledge do consider an hour of time with an elder law attorney. If your town has any center that helps with senior issues they may guide you to a resource.
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Usually when someone goes into a Nursing home on a permanent basis they switch to what is called a Special Needs Plan or SNP through Medicare. It is much cheaper and covers meds without any copay. Don't make any switches for her without discussing with the social worker at the Nursing Home. They will know which SNP will be the best fit for your Mom. as others here mentioned if this is a saleman calling he may not be looking for your Mom's best intest and is only looking at his commission.
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Its usually not the healthcare plan that is the problem it usually the medical group that is the problem. If you keep on top of the plan you will get what they tell you however the medical group says yes or no of who is the provider.
Example: My Daddy needed cataract surgery and the medical group wanted him to go to one of these 3rd world surgery outlets and I told them no this was not going to happen it took 6 1/2 months because of going back and forth. After filing two grievances I finally got, the correct person from United Healthcare on the phone and told them that if this didn't happen within the next 30days I was going to sue for pain and suffering. United Healthcare went to the medical group and gee whiz it was approved within 2 hours. Daddy had both eyes done within 45 days.
Remember the insurance doesn't want the law suit - the medical group wants to save money.
Blessings
hgnhgn
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Isthisrealyreal Mar 15, 2019
Was this an advantage plan?
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